Young children with cleft lip and/or palate are at risk for speech and language delays associated with structural deficits despite early surgical repair. This study proposes to evaluate the effectiveness of an early intervention to facilitate speech and vocabulary development and prevent the habituation of compensatory articulation use. This exploratory investigation consists of a pilot study to operationalize intervention components of an EMT (Enhanced Milieu Teaching) intervention with and without a phonological recasting emphasis (PE) and a randomized group study to compare the optimal combination of EMT/PE (determined in the pilot) to a traditional articulation therapy performed in the community. The pilot study will examine 4 children, 18-24 months of age, in a multiple baseline design. Following refinement of the procedures in the pilot study, a group study will examine the effectiveness of this intervention in 2 groups of children with clefts, 18-24 months of age, randomly assigned to a treatment (14 children) or community-based control group (CBI) (14 children). Specific aims of the group study includes: (1) examining the effects of a naturalistic vocabulary intervention to promote change in the sound inventories, speech accuracy and use of compensatory articulation for the children in the EMT/PE intervention group compared with the children in a control group, (2) comparing the effects of the EMT/PE intervention on the generalization of speech production changes to home use in the treatment and control groups, and (3) to determine if changes in vocabulary, sound inventory, speech sound accuracy and use of compensatory articulation are maintained 3 months after the conclusion of the treatment. The children will receive a comprehensive speech, language, hearing and cognitive assessment at the beginning of the study, and 3 and 6 months later, corresponding to the beginning, immediately following treatment and a 3 month follow-up. PUBLIC HEALTH RELEVANCE: This project examines treatment efficacy of an early intervention model for children with cleft lip and/or palate that promotes early normalization of speech and language development and prevention of compensatory articulation patterns. The intervention optimizes methods for promoting treatment generalization and maintenance through a collaborative parent-clinician implemented intervention delivered across clinic and home settings. This model will be compared to a traditional articulation treatment provided in the community.